Psychotherapy Consent Form
To see me for psychotherapy, download and print this form, complete and bring it to your first appointment. No other forms are needed.
Consent to Release PHI
There are times when you may want me to release information about you to others. Because our discussions are confidential (with the exceptions listed in my Privacy Policy - HIPAA) I will need your signed consent to release Protected Health Information (PHI). Release of information includes both written records and verbal information.
Print this form, complete and sign and return to me to allow me to release the information you are requesting be released.
Release PHI Incoming
There are times you may want another healthcare professional to talk to me or otherwise release information to me. They will want your authorization to release the Protected Health Information (PHI). This form should be completed and sent to the professional who will be releasing the information. Only the party releasing the information needs you consent.
Custody Evaluation Forms
If I will be conducting a child custody evaluation for you, print, complete and return these forms along with the required retainer fee and the Order of the Court.
Parent Questionnaire
For parties in a custody evaluation, right click on the icon below to open or save this questionnaire. Open it in your word procesor to complete.
Collateral Contact Form
For parties in a custody evaluation, please right click the icon below to open the collateral contact form.
Parent-Child Reunification Therapy
For reunification therapy for estranged parents and children, right click on the icon below, complete and bring to your first visit. If the other parent is financially obligated, have them complete and return the forms as well.
Special Master Forms
If you have been Court Ordered to use me as your Special Master, right click the icon to download the forms. Please read them carefully, complete where indicated, and return them to me with the required retainer fee and Order of the Court.
Special Master/Parenting Coordinator Stipulation and Order - Sample
Parenting Coordinator Forms
If you plan to use me for Parenting Coordination Services, please right click to download these forms. Then, read them, complete where indicated and return with retainer fee.
Divorce Mediation Forms
Divorce Mediation forms can be obtained here. Also see www.Mediation-Utah.com.
Other Forensic Evaluation Forms
If I am to conduct a court-related evaluation other than a custody/parent-time evaluation, complete this form and return it with retainer and court order (if any).
This would apply to parental fitness evaluations, second opinion reviews of other custody evaluations, etc.
Forensic Consultation Form
Right click the icon below if you want court related work (such as review of others' evaluations or testimony) that does not involve a current evaluation by Dr. Wehl.
